Infective endocarditis secondary to coagulase-negative staphylococcus revealed by endogenous endophthalmitis: Case...

Endogenous endophthalmitis is a rare disease which remains a diagnostic and therapeutic emergency. Infective endocarditis is the first etiology, and coagulase-negative staphylococcus is most often incriminated in endocarditis on prosthesis and rarely on native valve.

We report the case of a 70 year old female patient, who has a chronic renal failure on haemodialysis, admitted to the ophthalmology department in endogenous endophthalmitis. Blood cultures, intravitreal sampling and culture of the haemodialysis catheter were positive for a multi-sensitive coagulase-negative staphylococcus. On transthoracic and transoesophageal ultrasound, vegetation was found in the right atrium along the path of the haemodialysis catheter and in the aortic and mitral valves. The patient received intravenous antibiotic and intravitreal injections of antibiotics. The evolution was marked by a systemic improvement but the ocular prognosis was poor and the evisceration decision was taken.

Endogenous endophthalmitis is related to a metastatic infectious process secondary to haematogenous microbial dissemination. The germs involved are Gram-positive bacteria and occurs very frequently in predisposed conditions. A primary infectious site is found in 90% of cases and this is most frequently endocarditis. Coagulase-negative staphylococci are responsible for 20-45% of endocarditis in prosthetic valves and the prevalence in native valve endocarditis is considered low.

Endogenous endophthalmitis remains an emergency. The search for a source of infection, primarily endocarditis, is systematic. The improvement of the prognosis depends essentially on the eviction and early treatment of infectious foci in people at risk.